Fractured Maxillary Central Incisor Research Articles

Partial Pulpotomy of Immature Anterior Permanent Teeth with Complicated Crown Fractures: Report of Two Cases

Aim: This report aims to present the application of partial pulpotomy procedures in fractured maxillary central incisors with immature roots. The application of this treatment approach in fractured immature permanent teeth is advantageous but a number of challenges exist particularly when the affected teeth are severed with complicated fractures
 Methodology: Two cases of complicated crown fractures are reported. A 7-year-old male patient with broken maxillary left central incisor tooth and 8-year-old female patient with fractured maxillary right and left central incisor teeth were referred to the clinic after trauma. Partial pulpotomies were performed and MTA was applied directly onto the pulps.
 Results: Hard tissue barrier was observed after treatments.
 Conclusions: Partial pulpotomy is a valid treatment approach in which part of an exposed vital pulp is removed while preserving the vitality and function of the remaining part.
 
 How to cite this article: Sharawy WW, Ahmed HMA. Partial pulpotomy of immature anterior permanent teeth with complicated crown fractures: Report of two cases. Int Dent Res 2017;7:71-75.
 Linguistic Revision: The English in this manuscript has been checked by at least two professional editors, both native speakers of English.

Multidisciplinary treatment of a fractured maxillary central incisor

Subgingivally fractured incisors are still a challenge to treat. Restoration of severely damaged teeth requires careful attention and comprehensive preplanned treatment. Here, a patient who had traumatic injury to the upper left central incisor which led to an oblique fracture involving enamel, dental and extending into the root below the gingival margin was saved from extraction by accelerated forced eruption of a root portion, allowing placement of crown, and eliminating the need for a fixed partial denture. A tooth otherwise would have gone for extraction routinely was thus saved and restored through a multidisciplinary approach by a combined orthodontic, periodontal and endodontic treatment.

Reattachment of fractured anterior tooth fragment: An approach in endo esthetic view

Esthetic rehabilitation of crown fractured anterior teeth is one of the greatest challenges to the dental specialists in concern of long-term biological function. Traditional views demonstrate limitations with much controversy in MICD (Minimally invasive cosmetic dentistry) concept. To meet the challenge a new biological approach in endo esthetic view is considered. This case report represents the management of a fractured right maxillary central incisor tooth of 27 year-old-male patient where his own fractured tooth fragment restored by reattachment technique. The clinical examination revealed complicated crown fracture extended horizontally from mesial to distal and angulated incisally from palatal to labial with pulp exposure. The fracture was not evident labially. In this case, the procedure was used to repair the fracture tooth fragment included root canal treatment and glass fiber post for reinforcement. The tooth fragment was luted with light activated flowable composite resin. Onward assessment showed a stable reattachment, good esthetic and function with healthy periodontium.

Agreement Among Dental Students, Peer Assessors, and Tutor in Assessing Students’ Competence in Preclinical Skills

The aim of this study was to determine the level of agreement regarding assessments of competence among dental students, their student peers, and their clinical skills tutors in a preclinical skills program. In 2012-13 at the University of Edinburgh, second-year dental students learned to perform the following seven cavity preparations/restorations on primary and permanent Frasaco teeth: single-surface adhesive occlusal cavity; single-surface adhesive interproximal cavity; single-surface adhesive labial cavity; multi-surface adhesive cavity; multi-surface amalgam cavity; pre-formed metal crown preparation; and composite resin buildup of a fractured maxillary central incisor tooth. Each student, a randomly allocated student peer, and the clinical skills tutor used standardized descriptors to assign a competency grade to all the students' preparations/restorations. The grades were analyzed by chi-square analysis. Data were available for all 59 second-year students in the program. The results showed that both the students and their peers overestimated the students' competence compared to the tutor at the following levels: single-surface adhesive occlusal cavity (χ(2)=10.63, p=0.005); single-surface adhesive interproximal cavity (χ(2)=11.40, p=0.003); single-surface labial cavity (χ(2)=23.70, p=0.001); multi-surface adhesive cavity (χ(2)=12.56, p=0.002); multi-surface amalgam cavity (χ(2)=38.85, p=0.001); pre-formed metal crown preparation (χ(2)=40.41, p=0.001); and composite resin buildup (χ(2)=57.31, p=0.001). As expected, the lowest levels of agreement occurred on the most complicated procedures. These findings support the need for additional ways to help students better self-assess their work.

Prevalence of permanent anterior tooth fracture due to trauma in South Indian population

Abstract Aim: The aim of the study is to determine the prevalence of permanent anterior teeth fracture due to trauma in South Indian population. Materials and Methods: After formal consent, study was conducted on 2000 patients reporting for treatment in A B Shetty Memorial Institute of Dental Sciences and Rural Satellite Centers from June to December 2013. They were examined under good illumination using sterilized mouth mirror, explorer and cotton rolls. Results were evaluated using Pearson Chi-square test. Results: Of 2000 patients, overall prevalence of anterior teeth fracture due to trauma was 14.85%, 53.9% cases were noticed in the age group of 15-30 years, 20.2% cases in an age group of 12-15 years. Of 14.85% (297) cases, 53.9% males and 46.1% females had anterior teeth fracture, 88.67% cases were with respect to maxillary arch and 11.33% cases were with respect to mandibular arch. 43.9% patients had enamel and dentin fracture, only enamel fracture was seen in 31.6% patients and the least was 6.01% which showed displacement of tooth without crown or root fracture, 67% were because of falls and rest of the 33% of patients had anterior tooth fracture because of violence, sports and traffic accidents, 71.42% cases had fracture with maxillary central incisor. Furthermore, 59.6% cases were seen with Class II Division I malocclusion. Conclusions: In the present study we noticed that fall was the most frequent cause and are seen more in males with an increased prevalence in 15-30 years of age. Furthermore, fracture of maxillary central incisor was most common and among all, fractures involving enamel and dentin were most common.

Biological Restoration of a Fractured Anterior Tooth with the Use of Dentine Pin (Biopins).

This case study describes the esthetic and functional reconstruction of a fractured maxillary central incisor. Due to the requirement for additional retention, treatment was performed using the homogenous technique of biological restoration associated with cementation of posts made from human dentin (biopins). This type of treatment is a new alternative to conventional techniques and favors the dental esthetic and function, as well as biocompatibility, and is an inexpensive procedure.

The use of MTA/blood mixture to induce hard tissue healing in a root fractured maxillary central incisor. Case report and treatment considerations

To report the use of MTA/blood mixture for the induction of hard tissue healing of multiple horizontal root fractures in a maxillary incisor. An 18-year-old male patient was referred after suffering trauma to the anterior maxilla. Radiographic evaluation revealed multiple horizontal fractures in the middle and cervical third of his maxillary right central incisor. Clinical evaluation revealed third grade mobility of the coronal segment. The patient's accompanying radiographs revealed that root canal treatment of all segments had been previously initiated and both segments had been rendered pulpless. The coronal segment was repositioned and stabilized. A bi-antibiotic mixture, containing equal parts of ciprofloxacin and metronidazole, was used for the disinfection of the root canal segments. A blood clot was induced from the periapical area and MTA powder was mixed with the blood creating a bioceramic mixture covering all the fractures. Thick MTA was placed as a coronal barrier and the tooth was restored. Recall examination after 24months revealed healing of the horizontal fractures. The MTA mixed with the blood lost its radio-opacity over time. Tooth mobility returned to normal limits. A low range of 5-25% of all horizontally root fractured cases develop pulp necrosis, confined in the coronal segment, leaving the apical segment with vital tissue. In the unfortunate situation that the pulp of both segments becomes necrotic or the entire pulp tissue is removed, the use of MTA/blood mixture may be beneficial for the induction of hard tissue healing. MTA when mixed with blood seems to lose its radio-opacity over time.

Recreation with biological restoration: A root canal reconstruction

Traumatic injuries are frequent cause of anterior tooth fracture in dentistry. Biological restorations are the reconstruction of extensively damaged teeth with adhesive cementation of biological posts and crowns. This case report refers to the rebuilding of fractured maxillary central incisor through biological post and core in a 14-year-old child. This treatment option represents a low-cost and alternative technique for the aesthetics and functional rehabilitation of extensively damaged anterior teeth.

Multidisciplinary approach to a subgingivally fractured incisor tooth: A case report

This case report describes a multidisciplinary approach using orthodontic forced eruption to facilitate prosthetic restoration of a subgingivally fractured maxillary permanent central incisor. A 14-year-old male patient presented at the pediatric dental clinic due to unesthetic appareance and for management of a fractured maxillary right central incisor tooth. Intraoral examination revealed that the maxillary right central incisor had sustained a crown-root fracture with pulp exposure. We treated the tooth endodontically and performed orthodontic root extrusion with a modified Hawley appliance prior to prosthetic rehabilitation. Approximately 2–3 mm of extrusion of the tooth was obtained within 8 weeks. A fiber post was then inserted into the root canal, and final restoration was completed with an all-ceramic crown. Follow-up 18 months after treatment revealed good periodontal health, esthetics and normal function.

Retrieval of a fractured tooth fragment embedded in the lower lip

Traumatic injuries to the maxillary anterior teeth due to domestic accidents and contact sports leading to tooth fracture are a common finding in a pedodontic practice. Sometimes the fractured tooth fragment can penetrate into the surrounding soft-tissue and may be often missed in a routine clinical examination. This case report presents a 10-year-old boy who reported to the Department of Pedodontics, SRM Dental College with fractured maxillary right central incisors along with lower lip laceration due to trauma. Patient was subsequently diagnosed with a fragment of a fractured permanent central incisor in the lower lip after routine clinical examination and radiographic examination. Patient was initially seen at a private dental hospital, where the embedded dental fragment in the lower lip went unnoticed. The fragment was removed surgically and composite filing was done in the fractured central incisor at a later stage. This report highlights the importance of thorough clinical examination followed by radiographic examination in patients reporting with dental fractures due to trauma.

An interdisciplinary approach to treat crown-root-fractured tooth

Restoration of a crown-root subgingival fractured tooth, especially at anterior aesthetic zones is still a great challenge for restorative dentists. Crown lengthening procedure alone has the disadvantage of high gingival curve of the final restoration, which was not discontinuous to adjacent teeth and thus compromise cosmetic outcomes. The objective of this report is to display a new interdisciplinary approach which combining endodontic root canal treatment, orthodontic extrusion, periodontal crown lengthening surgery and prosthodontic post-core-crown restoration procedures to restore a crown-root subgingival fractured maxillary central incisor and achieved a satisfied cosmetic result. Computer-based spectrophotometer was also used to accurately select colour without objective interference to achieve ideal cosmetic effects.

The Use of Leukocyte- and Platelet-Rich Fibrin During Immediate Postextractive Implantation and Loading for the Esthetic Replacement of a Fractured Maxillary Central Incisor

I mplant-supported restoration of the maxillary anterior segment that is biologically, functionally, and esthetically acceptable following traumatic injuries in the maxillary anterior segment is always complex. Careful extraction of the fractured root, residual labial bone preservation, proper flap design, ideal positioning of the implant, appropriate softtissue contour, and the crown emergence are all important steps necessary to achieve a predictable, stable, functional, and esthetic success. However, healing of the tissues is always difficult to control and the development of new techniques and materials to improve these treatments is still necessary. The use of platelet concentrates is an interesting approach. Platelet concentrates for surgical use are widely used and continuously investigated in oral and maxillofacial surgery. The objective is to gather platelet growth factors and to inject them on a surgical site to stimulate the healing process. A significant percentage of the literature is focused on the platelet-rich plasma (PRP) families. PRP is a liquid platelet suspension often activated into a platelet-rich gel (like fibrin glues). Another technology called leukocyteand platelet-rich fibrin (L-PRF) allows for the preparation of strong fibrin membranes enriched with cells (activated platelets, leukocytes, circulating cells) and platelet growth factors. This autologous healing biomaterial is free of additives (no anticoagulant during blood harvest, no chemicals for activation), simple, inexpensive, and quick to prepare (15 minutes for all steps). This technique is specifically adapted to the practical needs in daily implant dentistry. Several articles have reported the use of these L-PRF membranes for the stimulation of bone and 1 Private practice, Turin, Italy. 2 Private practice, Ra’anana, Israel. 3 Clarion Research Group, Clarion, Penn. Department of Restorative Dentistry, State University of New York at Buffalo, Buffalo, NY. 4 LoB5 Unit, Research Center for Biomineralization Disorders, School of Dentistry, Chonnam National University, Gwangju, South Korea. Department of Stomatology, Oral Surgery, and Dental and MaxilloFacial Radiology, School of Dental Medicine, University of Geneva, Geneva, Switzerland. * Corresponding author, e-mail: LoB5@mac.com DOI: 10.1563/AAID-JOI-D-12-CL.3802

Forced orthodontic extrusion and use of CAD/CAM for reconstruction of grossly destructed crown: A multidisciplinary approach

The aim of this study is to present a report of a case where forced orthodontic extrusion and computer-aided design and computer-aided manufacturing (CAD/CAM) technique was used for reconstruction of right maxillary central incisor with grossly destructed crown. Aesthetic rehabilitation of a fractured maxillary right central incisor was performed employing a multidisciplinary approach i.e. conventional endodontic treatment followed by orthodontic extrusion and final restoration using CAD-CAM and one piece milled zirconia post and core with full coverage zirconia crown. After the procedure being completed, periapical radiographs taken at 3 month follow up period demonstrated that the post and core remained well adapted to post space and there was a complete healing of periapical lesion. This technique can provide a complete aesthetic rehabilitation of a grossly destructed tooth without hampering the biological width and thus has a better prognosis.

Reattachment of the Original Crown Fragment

AbstractCrown fracture is the most common type of dental injuries. One of the options of management of crown fracture is fragment reattachment, whenever intact tooth fragment is available after trauma. The fragment reattachment procedure presents a conservative, simple and esthetic alternative. This article presents two case reports of restoration of fractured maxillary central incisor using fragment reattachment.

Fracture resistance of microhybrid composite, nano composite and fibre-reinforced composite used for incisal edge restoration

Traumatized anterior teeth need quick, aesthetic and functional repair. Along with aesthetics, the physical properties of restorative material should also be considered for long-lasting restoration. Fibre reinforcement has been tried as a newer technique to improve the physical properties of composite materials. Hence, this study was carried out to evaluate the fracture resistance of microhybrid composite, nano composite and fibre-reinforced composite used for restoration of incisal edge of fractured maxillary central incisors. Extracted permanent maxillary central incisors were randomly divided into four groups of 10 samples each: control group with intact teeth (Group A), microhybrid composite (Esthet X; Dentsply/Caulk, Milford, DE, USA) (group B), nano composite (Ceram X; Dentsply/Caulk) (group C) and microhybrid composite reinforced with polyethylene fibre - flowable composite unit [(Ribbond THM; Ribbond Inc., Seattle, WA, USA; Esthet X flow; Dentsply/Caulk)] (group D). The fracture resistance was measured under universal testing machine at a speed of 1mmmin(-1) with the loading tip of 2mm diameter. The samples were further evaluated for mode of fracture under stereomicroscope at 3.5× magnification. The data were analysed using one-way anova and Tukey's test for fracture resistance. Group A and group D exhibited significantly higher fracture resistance than group B and group C. No significant difference was found between group B and group C as well as between group A and group D. Fisher's exact test for the mode of fracture revealed no statistical significance. It was concluded that fibre reinforcement of composite could be an alternative technique for restoration of fractured anterior teeth for better aesthetics and longevity of the restoration.

Immediate implant placement and provisionalization with simultaneous guided bone regeneration in the esthetic zone

The procedure for immediate implant placement and provisionalization is time-saving, possibly with only one surgical intervention required, although allowing maximal preservation of peri-implant tissues. In this case, we extracted a fractured maxillary right central incisor of a 46-year-old woman with high esthetic expectations, and a transmucosal implant was immediately installed. Simultaneous guided bone regeneration was performed to correct the defects at the facial side of the socket and augment the alveolar ridge horizontally. Primary stability of the implant body and wound closure without tension were confirmed. Connection of a 15° angled abutment and fabrication of a provisional acrylic resin crown without occlusal contact were also completed in the same appointment. After intensive follow-up and soft-tissue molding for 6 months, the customized zirconia abutment and all-ceramic crown were definitively fabricated. During the 18-month follow-up period, the patient was satisfied with the esthetic and functional results.

An interdisciplinary approach to reconstruct a fractured tooth under an intact all ceramic crown: Case report with four years follow up

Trauma causing the fracture of a restored tooth with the extracoronal full coverage prosthesis remaining intact is a common occurrence in dental practice. Reconstruction of the damaged tooth foundation and recementation of the crown can pose quite a challenge for the restorative dentist. This case report describes an innovative interdisciplinary chairside technique for the recementation of an all-ceramic crown on a fractured maxillary central incisor. The course of care described is effective, affordable, and saves time in comparison with other treatment options for such clinical situations.

A single visit re-attachment of fractured coronal tooth fragment - A case report

Traumatic fracture of anterior teeth is one of the common dilemmas faced by the dentist during daily practice. Maxillary incisor are the most common teeth involved in facial trauma and most of the time, dental anterior crowns are damaged. An unrestorable tooth should be extracted and this may lead to more complex treatments such as implant or conventional prosthetic rehabilitation, which will restore function but impair esthetics. This case report present a clinical technique for the restoration of a fractured maxillary central incisor, by reattaching the fracture coronal tooth fragment using a Para post and resin composite restoration. A challenging, conservative and economically viable procedure with in the compass of a single visit.

Biomechanical behaviour of a fractured maxillary incisor restored with direct composite resin only or with different post systems

To compare stress distribution between a fractured maxillary central incisor restored with direct composite resin only (CR) or associated with different post materials, using finite element analysis. A three-dimensional model of a sound maxillary central incisor and supporting structures was constructed, using data from the dental literature. Changes were made in the crown region to create a tooth with a restored crown fracture. A composite resin restoration only and restorations associated with different tapered post systems (glass fibre, carbon fibre, titanium and zirconia ceramic) were also evaluated, resulting in six experimental models. A static chewing pressure of 2.16Nmm(-2) was applied to two areas of the palatal surface of the tooth. Stress distribution was analysed under a general condition and in the structures of the models separately. The maximum stresses were concentrated as follows: at the cemento-enamel junction in the model with a sound maxillary central incisor, restored with CR and with a composite resin restoration associated with fibre posts; in the enamel at the post-enamel interface on the palatal surface of the model with a titanium post; and in the post of the model with zirconia ceramic post. None of the restorations evaluated was able to recover the stress distribution of the sound tooth. The models restored with composite resin associated with a glass or carbon fibre post had similar stress distributions to that of the model restored with CR. The different post materials were shown to have a substantial influence on stress distribution, with less stress concentration when fibre posts were used.

Retrofitting a tooth-supported crown with an implant and abutment: A clinical report

This article presents a treatment option for a fractured maxillary central incisor root as part of an existing complete maxillary rehabilitation. After the root extraction and immediate implant placement into the extraction socket, an acrylic resin removable partial denture (RPD) was placed. Six months later, a screw-retained provisional restoration was placed to guide the development of soft tissue contours. An impression was made, and a custom abutment was fabricated to conform to the new gingival profile and the intaglio surface of the existing metal ceramic crown. The custom abutment was placed and the preexisting metal ceramic crown was then cemented.